Hernia under the rib cage: Epigastric Hernia: Symptoms, Diagnosis, and Treatment

28.07.202318.07.2023 by alexxlab

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Epigastric Hernia: Symptoms, Diagnosis, and Treatment

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Medically reviewed by Andrew Gonzalez, M. D., J.D., MPH — By Diana Wells — Updated on August 29, 2017

Overview

A hernia is a generic term for a hole caused by a weak spot in your abdominal wall. An epigastric hernia is a type of hernia in the epigastric region of the abdominal wall. It’s above the belly button and just below the sternum of your rib cage.

This type of hernia is a somewhat common condition in both adults and children. About 2 to 3 percent of all abdominal hernias are epigastric hernias. It’s also seen in infants.

Most of the time, you’ll have no symptoms or only minor symptoms with an epigastric hernia. A lack of symptoms means that this condition tends to go unreported.

An epigastric hernia usually causes a bump to occur in the area below your sternum, or breastbone, and above your belly button. This bump is caused by a mass of fat that has pushed through the hernia.

The raised area may be visible all the time or only when you cough, sneeze, or laugh. This bump, or mass, can grow and become larger in some cases. You can have more than one epigastric hernia at a time.

An epigastric hernia can also cause tenderness and pain in the epigastric region. However, it’s common for an epigastric hernia not to show any symptoms.

An epigastric hernia can occur when the tissues in the abdominal wall don’t close completely during development. Research continues to look for the specific causes of this type of hernia. Not as much is known about epigastric hernias possibly because they aren’t reported many times due to a lack of symptoms.

However, one theory has gained some credibility. It’s believed that the epigastric hernia may be caused when there is tension in the area where the abdominal wall in the epigastric region attaches to the diaphragm.

This type of hernia won’t go away on its own, and complications will eventually lead you to surgery. Surgery is the only way to repair an epigastric hernia. It’s the recommended treatment, even for infants, due to the risk of the hernia enlarging and causing additional complications and pain.

To complete the repair, you might only need sutures, or you may require an implanted mesh. The use of mesh or sutures is determined by the size of the hernia and other factors.

If your epigastric hernia hasn’t been treated, you should get medical treatment immediately if you have vomiting or fevers and an increase in abdominal pain. These may indicate a bowel blockage.

Surgery to repair an epigastric hernia can lead to certain serious complications. If you have any of the following symptoms after surgery, you should seek medical attention:

high fever
difficulty urinating
discharge from the surgical site
an increase in pain or swelling at the surgical site
bleeding that won’t stop
nausea
vomiting

The complications for an untreated epigastric hernia include the following:

enlarged hernia, which eventual allows parts of the bowel to push through
increase or onset of pain and tenderness
bowel blockage
loss of domain, in which the hernia becomes so large that’s nearly impossible to repair even with a mesh

The complications for the surgical repair of epigastric hernia includes any basic complications surrounding surgery and general anesthesia as well as those related to this specific surgical procedure. These complications may include:

bleeding
pain
wound infection at the surgical site
scarring left after healing
blood clots
development of a lump that isn’t a hernia
a low chance of the hernia recurring
mesh infection (in the event an artificial mesh is used to repair the hernia)

Surgical repair of an epigastric hernia is a common procedure and has a very positive outlook. Most people are able to go home the same day as the surgery.

You might even be able to return to work or school within a day or two with some minor restrictions. Specifically, most surgeons don’t want you lifting any weight heavier than a gallon of milk for six to eight weeks.

Your doctor will tell you how quickly you should return to your normal activities. Usually, your restrictions will include no heavy lifting and no strenuous activities or sports for a brief period of time.

Last medically reviewed on August 28, 2017

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Coats RD, et al. (2000). Presentation and management of epigastric hernias in children [Abstract]. DOI:
10.1053/jpsu.2000.19242
Corsale I, et al. (2000). Diagnosis and treatment of epigastric hernia. Analysis of our experience. [Abstract].
ncbi.nlm.nih.gov/pubmed/11155474
Debrah SA, et al. (2013). Epigastric hernia in pregnancy: A management plan based on a systematic review of literature and a case history. DOI:
10.1007/s12262-012-0632-3
Epigastric hernia repair. (n.d.).
ruh.nhs.uk/patients/services/upper_gi/documents/epigastric_hernia4.pdf
Parsons S. (2010). Epigastric hernia repair.
bmihealthcare.co.uk/treatments/general-surgery/epigastric-hernia-repair
Ponten JE, et al. (2012). Pathogenesis of the epigastric hernia. [Abstract]. DOI:
10.1007/s10029-012-0964-8
Venkatesh M, et al. (n.d.). Epigastric hernia.
radiopaedia.org/articles/epigastric-hernia

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Medically reviewed by Andrew Gonzalez, M.D., J.D., MPH — By Diana Wells — Updated on August 29, 2017

Epigastric hernia repair (adult) | healthdirect

This page will give you information about an epigastric hernia repair. If you have any questions, you should ask your GP or other relevant health professional.

What is an epigastric hernia?

An epigastric hernia is a lump in the midline between your belly button and sternum (breastbone) which can cause pain.

Your abdominal cavity contains your intestines and other structures. These are protected by your abdominal wall, which is made up of four layers.

In an epigastric hernia, fat pushes out through a weakness in the wall of your abdomen between your belly button and sternum and forms a lump. The most common symptom is pain caused by the fat being pinched by your abdominal wall.

An epigastric hernia repair (adult).

What are the benefits of surgery?

Surgery can help to relieve pain that is caused by the hernia.

Are there any alternatives to surgery?

The hernia can be left alone but pain caused by the hernia will usually continue and complications can happen. It will not get better without surgery.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible.

The operation usually takes about 30 minutes. Your surgeon will make a cut over the hernia and free up the ‘hernial sac’.

If only fat is pushing through, your surgeon will either remove the fat or push it back. If contents of your abdomen are also pushing through, they will place the contents back inside your abdomen.

Your surgeon will remove the hernial sac and close the weak spot with strong stitches or a synthetic mesh.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Do not do exercises that involve heavy lifting or make your hernia painful. Before you start exercising, ask the healthcare team or your GP for advice.

If you have not had the coronavirus (COVID-19) vaccine, you may be at an increased risk of serious illness related to COVID-19 while you recover. Speak to your doctor or healthcare team if you would like to have the vaccine.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

bleeding
infection of the surgical site (wound)
allergic reaction to the equipment, materials or medication
blood clot in your leg
blood clot in your lung
chest infection

Specific complications of this operation

developing a collection of blood (haematoma) or fluid (seroma) under your wound
injury to structures within your abdomen

Consequences of this procedure

pain
unsightly scarring of your skin

How soon will I recover?

You should be able to go home the same day.

You should be able to return to work after 1 to 2 weeks, depending on how much surgery you need and your type of work.

Do not lift anything heavy for at least 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery and can return to normal activities. The hernia can come back many years later and you may need another operation.

Summary

An epigastric hernia is a common condition caused by a weakness in your abdominal wall between your belly button and sternum. If left untreated, an epigastric hernia can cause serious complications.

IMPORTANT INFORMATION

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Learn more here about the development and quality assurance of healthdirect content.

Diagnostics and methods of treatment of intercostal hernia

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Intercostal hernia in female and male patients is diagnosed with the same frequency. Pathology is accompanied by degeneration of muscle tissue. The probability of the appearance of dystrophic changes increases under the influence of an inactive lifestyle, impaired posture, and alcohol abuse.

Positive dynamics in 97% of cases

The results of the treatment course are confirmed by control MRI images.

No side effects

The methods used in our clinic are safe and have no side effects.

Long-term effect

Treatment minimizes the risk of new hernias in other segments, as well as hernia recurrence.

What is the disease

The patient is diagnosed with an abnormal location of the pleural membrane, which is accompanied by defragmentation of the lung alveolar tissue. In this case, the hernial sac protrudes into the formed hole. With such a disease, the condition of the intercostal muscles worsens.

In the spine treatment clinic of Dr. Length, it is possible to correct intercostal hernia without surgery. Manual therapy helps to eliminate the defect in muscle tissue in the affected area, which reduces the risk of recurrence.

The main causes of development

As a rule, the formation of a hernia occurs under the influence of several provoking factors:

Previous injuries (fractured ribs, sprain, contusion of the chest).
Scoliosis.
Osteochondrosis, accompanied by degenerative-dystrophic changes. With this disease, the condition of the cartilaginous tissue of the structures of the ribs and spine worsens.
Bronchial asthma. This pathology is characterized by attacks of shortness of breath and cough. In this case, there is an increase in intracavitary pressure in the chest, which causes protrusion of the intercostal space.
Chronic pathologies of the respiratory system (pleurisy, emphysema, chronic bronchitis of various nature, chronic obstructive pulmonary disease).
Ascites, which is accompanied by a sharp increase in intra-abdominal pressure.
Occupational activities of the patient. The high-risk group includes musicians who play wind instruments, glassblowers.

One of the reasons for the appearance of pathology is the deterioration of the tone of the intercostal muscles, which develops against the background of the formation of Schmorl’s hernia. In this case, the motor fibers of the spinal roots are infringed.

Types of disease

Selected types of intercostal hernia are listed in the table below.

Type of intercostal hernia	Appearance mechanism
Spontaneous	Develops in conditions that are accompanied by severe hypoxia. In this case, there is a rapid increase in pressure in the lungs. Spontaneous intercostal hernia occurs with a sharp rise in heavy objects, a critical situation on the water. At such moments, there is a rapid protrusion of the parenchymal lung tissue.
Postoperative	Such a hernia is one of the serious complications of a thoracotomy (a surgical operation on organs located in the chest area). Postoperative hernia is one of the consequences of an unsuccessful dissection of the intercostal muscles.
Post-traumatic	Occurs against the background of penetrating wounds, bruises, falls, blows. A rupture of the intercostal muscles remains at the site of injury, causing a cyst or hernia.
Chronic secondary	Develops in violation of the functions of the bronchopulmonary system, the main symptom is a prolonged, painful cough. These pathologies include: • recurrent pneumonia; • bronchial asthma; • whooping cough; • individual forms of tuberculosis; • chronic obstructive pulmonary disease

Treatment success is 90% dependent on experience
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During the consultation, we carry out a thorough diagnosis of the entire spine and each segment. We are exactly
we determine which segments and nerve roots are involved and cause symptoms of pain. As a result of the consultation
We give detailed recommendations for treatment and, if necessary, prescribe additional diagnostics.

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The most dangerous location of the hernia is in the upper intercostal spaces (on the left side). Such a pathology often provokes a deterioration in hemodynamics in the systemic circulation. At the initial stage of the disease, a partial dislocation of the heart muscle is often diagnosed.

When the pathology is localized in the region of the apex of the lung, the cicatricial deformity of the organ progresses rapidly. This can lead to the development of chronic respiratory failure.

Main signs and diagnosis

Degenerative intercostal hernia is often characterized by lability. It is noticeable during a deep breath, a prolonged attack of coughing. In a normal state, such a hernia completely disappears. Pathology has no pronounced symptoms. A degenerative intercostal hernia is often discovered by chance, during an examination by an osteopath. Such a pathology is dangerous because with its sudden infringement, necrosis of lung tissue can occur.

When an intercostal hernia is located on the right side, there is a periodic tingling sensation in the affected area. Discomfort is aggravated by a sharp turn in the prone position. Increased pain is provoked by:

fall;
increased physical activity;
pathology of the abdominal organs.

One of the most informative methods is magnetic resonance imaging. This technique is used for the differential diagnosis of intercostal hernia with cancer.

Computed tomography is an x-ray method that involves layer-by-layer scanning of tissues. The technique allows you to accurately identify the localization of adverse changes.

Methods of treatment

When treating a disease, the following therapeutic methods are used:

performing a special course of therapeutic exercises designed to strengthen the muscular frame of the back;
reflexology to stimulate the process of regeneration of affected tissues;
osteopathy, which improves the circulation of lymphatic fluid in the focus of pathology.

The course of treatment is developed individually. You should first make an appointment with a chiropractor in our clinic.

Medicines

Your doctor may prescribe the following drugs:

Non-steroidal anti-inflammatory drugs. Such drugs have a complex effect. Non-steroidal anti-inflammatory drugs eliminate pain, reduce swelling, and eliminate the inflammatory process. Medicines are taken strictly for a limited time. Otherwise, there is a negative effect on the mucous membrane of the digestive tract.
Glucocorticoids. Means are prescribed for severe pain syndrome. Glucocorticoids are known for their pronounced anti-inflammatory and analgesic properties. Means are taken strictly in the dosage prescribed by the doctor.
Vitamin and mineral preparations that enhance immunity. These products provide the body with essential nutrients.
Cough suppressants. Assign as part of a comprehensive treatment of the disease in the event that a cough provokes an increase in hernia. In this case, mucolytics, expectorant drugs, preparations for inhalation and rinsing are used.

Traditional methods

As part of complex therapy, traditional methods can be used:

Herbal teas based on oregano, St. John’s wort, chamomile, thyme. Medicinal plants have antiseptic, anti-inflammatory properties. Herbal teas stimulate the rapid discharge of sputum. Homemade drinks have a soothing effect on the irritated pharyngeal mucosa in people with tobacco dependence.
Rubbing camphor oil on the chest. The warming procedure has a positive effect on blood circulation. Rubbing with camphor oil improves blood microcirculation in the affected part of the lungs.

Folk methods are resorted to only after consulting a doctor. Before using such products, you should make sure that there is no allergic reaction to the components.

Possible complications

In the absence of timely treatment, the risk of the following complications increases:

Pleurisy. The inflammatory process in the region of the pleural petals occurs due to the compression of part of the lung by the ribs.
Shortness of breath, breathing problems.

One of the consequences of the disease is an increase in the size of the protruding lung fragment. This often causes the patient considerable discomfort in everyday life.

Other diseases that are successfully treated in the spine clinic Doctors Length

You should also contact the clinic if you have the following pathologies:

arthrosis of the knee joint;
pain in the tendons;
bursitis of the knee;
spinal dysplasia in adults.

Doctors Length’s Spine Clinic also provides assistance in the treatment of gonarthrosis. As part of the complex therapy of the disease, taping, orthopedic insoles, and the unique Di-Tazin therapy method are used.

Treatment of intercostal hernia in the clinic helps to get rid of pain. When using effective therapeutic methods, the nutrition of the affected tissues improves.

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Mikhailov Valery Borisovich

Manual therapist, vertebrologist, neurologist

Work experience – 25 years

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Articular block in the neck neck

Dr. Length clinic I came with spinal problems. With two intervertebral lower hernias and two intervertebral hernias in the neck. I was assigned a comprehensive 10 step program. For 4 months, my lower vertebrae completely disappeared and crunches in my neck disappeared . ..

Lumbo-sacral hernia

“After the first time, my back stopped hurting. I felt relieved. Now 7 sessions have already passed and the back really does not hurt. I began to forget about it. And at first it hurt a lot.”

Inflammation of the sciatic nerve

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Pain in the lower back and leg

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I want to express my deep gratitude for the fact that I was put on my feet in the truest sense of the word. I came to the clinic a month and a half ago with severe pain in the lower back and leg. These complaints were long enough and the treatment that I used in the past was ineffective. Fortunately, I ended up in the clinic of Dr. Length and his team of super professionals!

Osteochondrosis of the cervical spine

“I applied 2 months ago with osteochondrosis of the cervical spine. I have a sedentary job and my neck muscles were very cramped. It was impossible to work. Before that, I went to other doctors, but this did not solve my problem. For 2 months I have a fairly positive dynamics. Every week it gets better and better.”

Bechterew’s disease

“I have had Bechterew’s disease for 10 years. The vertebrae began to move out, I began to slouch. I turned to other chiropractors, very famous, media ones. In the end, I didn’t get any results. After 2 sessions I felt much better. Now I don’t have any pain.”

Pain in the spine

“I came in with problems in my back, cervical, thoracic and lumbar spine. I was prescribed procedures, had a massage, and was assigned to do physical education at home. This made it much easier for me. I’m already turning my head. I have no pain.”

Shoulder shoulder periarthrosis

I went to the clinic with severe pain in my shoulder. My hand did not rise, I could not sleep at night, I woke up from pain. After the first treatment session, I felt much better. Somewhere in the middle of the course, my hand began to rise, I began to sleep at night.

Osteoarthritis of the knee joint, 2nd degree

Came in with a very serious illness. I could not walk, I have arthrosis of the 2nd degree of the knee joint. I went through a course of treatment at the Clinic and now I am going 100%.

Herniated disc

“I came to the clinic after I had back pain and it turned out to be a herniated disc. I went to other places, but they only relieved attacks of pain. Hope for a return to normal life was given only by Sergei Vladimirovich, his golden hands!

Scoliosis

“Since I was a teenager, I have suffered from scoliosis in the thoracic region. I felt a feeling of discomfort, tension, periodic pain in the spine. I turned to various specialists, a massage therapist, an osteopath, but I did not feel a strong effect. After treatment, Length S.V. I almost have a straight spine. Currently, I do not feel any problems and discomfort. ”

Intervertebral hernia

“At the 5th-6th session there was an improvement. I felt much better. The pain is gone. Improvement progressed more and more each time. Lesson 10 today. I feel great.”

Pain in the lumbar and cervical region

“I am 21 years old. I went to the clinic with discomfort in the lumbar and cervical region. I also sometimes had sharp pains. After undergoing therapy, I felt a significant improvement in my back. I have no pain. The condition as a whole has improved.”

Pain in the back

“At the beginning of the path of treatment, my back hurt very badly. I could no longer walk. I take 5 steps and stop. My entire journey consisted of such stops. In the very first procedure, I left the office with no pain in my spine.”

Cervical hernia

“I came in with a problem in my neck and my right arm was very sore. The neck did not turn, the hand did not rise. After the 3rd session, I felt better. After the 5th, all this pain began to decrease. It turns out I have 2 hernias in my cervical vertebrae. After the sessions, I did an MRI and one hernia decreased. Now he began to move, his hand earned.

Pain in the neck

“I went to Dr. Long because I had a very bad pain in my neck on the right side. I fell on a snowboard 5 years ago, even went to an osteopath, but somehow it didn’t really help. Now everything is fine, there are some consequences left, the muscles were spasmodic. When I came, I had steel muscles, now my neck is very soft.”

Pain in the thoracic region

“I went to the clinic with back pain, namely in the thoracic region. After 10 sessions of treatment, I could already calmly go about my usual business, stay at work until lunch, without howling in pain. Now I’ve come back for an adjustment after 2 months. I’m fine, my back doesn’t hurt.”

Hernia and protrusion

“I came to the clinic with L4-L5 hernia and L5-S1 protrusion. Today the course of treatment has ended. Lower back hurt, it was difficult to bend down. After completing the course and receiving instructions in the form of physical exercises, it became much easier. After a month of treatment, I do not feel any stiffness of movements. ”

Pain in the lower back and hip joint

“I have been suffering from back pain since I was young. When they became unbearable, I went to Dr. Length’s clinic. Already after the first procedure, the pain in the hip joint was gone. After the third procedure, the shooting pains in the lower back stopped.

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Relieve pain and inflammation

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Eliminate the cause of the disease

Comprehensive rehabilitation of the spine improves well-being: you feel a surge of strength and energy.

Let’s start the process of regeneration

The process of restoration of damaged tissues begins, hernias and protrusions decrease.

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All about hernias

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ALL ABOUT HERNIAS

What is a “hernia”?
A hernia is a protrusion of the abdominal organs under the skin through weak points in the abdominal wall. The outgoing organs are located in the hernial sac formed by the peritoneum (the inner lining of the abdominal wall). In the hernial sac, there can be almost any organ of the abdominal cavity (intestinal loops, bladder, less often – the stomach or part of it), the omentum, extremely rarely – the liver, spleen.

Fig. Incisional ventral hernia

Why does a hernia occur?
The abdominal wall, consisting of muscles and aponeuroses, performs a number of functions, one of which is holding the internal organs in their natural position and counteracting the intra-abdominal pressure they create. Under the action of intra-abdominal pressure, a defect (hernial orifice) can form in the weakest places of the abdominal wall, through which a hernia emerges. Predisposing factors such as:

Increasing intra-abdominal pressure may contribute to this

1. excessive exercise

2. severe cough, including chronic (smoker’s cough)

3. constipation

900 02 4. diseases in which shortness of breath develops with difficulty exhaling (bronchial asthma)

Conditions and diseases associated with the development of weakness of the connective tissue (obesity, varicose veins of the legs, congenital pathologies of the connective tissue, hereditary predisposition)
Patients previously operated on for hernia are also at risk for predisposing factors
A hernia may go unnoticed or be accompanied by intense pain. In the future, under the influence of the same factors, a gradual increase in hernia occurs, up to the exit of most of the abdominal organs into the hernial sac.

Who can get a hernia?
Any person can develop a hernia, regardless of gender or age.
External signs and symptoms.
The appearance and symptoms of hernias may develop gradually or occur over a short period of time.

Feeling of pressure, weakness or pain in the abdomen, groin or scrotum, arising or aggravated by exertion, straining.
Visually defined “bulging”, bulge on the abdomen, in the inguinal region, scrotum, appearing or increasing in size during physical exertion, straining. Also, in the area of the above formations, a feeling of discomfort or pain may appear during physical exertion, coughing, straining.

If you have any of the above symptoms, you should consult your doctor. The sooner the diagnosis is made and treatment is carried out, the higher the chance of preventing the development of complications, sometimes fatal.

Learn more about hernia types.

Fig. Classification of hernias of the anterior abdominal wall

Lumbar hernias of the anterior abdominal wall walls . The main anatomical formations through which lumbar hernial formations arise are the Petit triangle (Petit) and the Greenfelt-Lesgaft gap, aponeurotic fissures.
Petit’s triangle is bounded behind by the outer edge of the broad back muscle, in front by the inner edge of the external oblique muscle, from below by the iliac crest. In the region of the Petit triangle, under the superficial fascia and thin aponeurosis, there is an internal oblique muscle.
The Greenfelt-Lesgaft interval often has a quadrangular shape. Its upper border is formed by the lower serratus posterior muscle and the XII rib, medially it is delimited by the longitudinal muscles of the spine, the square muscle of the lower back, and the edge of the internal oblique muscle runs in front and below. The shape and size of the gap can vary depending on the length of the XII rib – with a long rib, the Greenfelt-Lesgaft gap is sometimes absent or looks like a gap, and with a short rib it increases in size.
Aponeurotic fissures usually form at the site of passage of vessels and nerves, but can sometimes appear as a result of rupture or maldevelopment of the aponeurosis. Among the causal factors contributing to the occurrence of hernial formation in these areas is the weakness of the connective tissue and muscle atrophy, inflammatory processes. Hernial protrusions are more common on the left than on the right, bilateral are rare.

Recurrent hernias
They are a complication of surgical treatment of hernias.
The causes of recurrent hernial protrusion may be related to the patient’s lifestyle and structural features of his body.

For example: non-compliance with the terms of the recovery period, when a person begins active physical activity ahead of schedule.
With age-related changes and a number of pathological conditions, when tissues can become flabby, change elasticity and structure, which also affects the quality and duration of healing after the operation. So in elderly, malnourished or very obese patients, relapses can be observed regardless of the method of operation and the course of the postoperative period
Main causes of recurrent hernia formation:

errors related to surgical technique
connective tissue deficiency
wound infection during or after surgery
excessive physical exertion, especially shortly after surgery

The only treatment for recurrent hernias is surgery. At the same time, various methods of hernioplasty are selected using various mesh prostheses.

Fig. Removal of old and deformed graft

Fig. Restoration of the integrity of the inguinal canal and reprosthetic hernioplasty according to Liechtenstein

Why is a hernia dangerous?
In addition to the obvious inconvenience associated with the presence of a cosmetic defect, reduced physical activity and ability to work, a hernia carries the risk of developing a number of complications. These include violations of the functions of organs located in the hernial sac – constipation, urination disorders, with the release of large volumes of organs from the abdominal cavity – respiratory disorders. A formidable complication is the development of hernia incarceration.
Incarceration – compression of the hernia in the hernial orifice, resulting in the development of necrosis of the contents of the hernial sac. The infringement is accompanied by a sharp pain in the area of the hernial protrusion. The most dangerous in case of infringement is the development of intestinal obstruction (the loop of the intestine is infringed) and the peritonitis that follows it. This situation requires immediate resolution through surgery. By and large, regardless of which organ is the contents of the hernial sac, the end result without appropriate treatment is one – peritonitis, the difference is only in time. Peritonitis – inflammation of the peritoneum – a formidable complication of a large number of diseases, including strangulated hernias, the development of this pathological condition is one of the most difficult problems in surgery. Age, obesity, the presence of concomitant pathology further exacerbate this situation. Without surgery, the only outcome is death. Even if the operation is performed, but more than a day has passed since the infringement began, up to 30% of patients die in the postoperative period. No need to bring such a small problem as a hernia to such a tragic situation.

How is a hernia treated?
The only way to treat a hernia in adult patients is to perform an operation (hernia repair).

When should a hernia be treated?
Following from the above, the earlier the operation is done, the better.

Is it possible to do without surgery?
-No.
For adult patients with a hernia, the only treatment is surgery.

Are there any contraindications for surgery?
Herniotomy should not be performed in the presence of severe concomitant pathology, when the operation can only harm, not help. Such cases include: the coming months after myocardial infarction, stroke, a number of other extremely severe comorbidities. It should be remembered that the presence of chronic diseases is not an absolute contraindication to the operation, but only requires appropriate correction in the preoperative period.

Can other surgeries be performed at the same time as hernia surgery?
Yes. An operation for a hernia can be supplemented by almost any surgical intervention.
Often, especially in older patients, there are several problems that require surgical intervention. In such situations, it is preferable to get by with one operation that combines the removal of a hernia and some other problem. The implementation of combined operations is a priority method, as it allows solving two (or more) problems in one surgical intervention, relieves the patient of psycho-emotional problems associated with the need to undergo several operations.

What types of operations are performed to repair a hernia?
To date, more than 300 methods of hernia repair are known – ventral, inguinal, umbilical, femoral, postoperative. But all of them can be fundamentally divided into two groups:

with plasty with own tissues – tissues of the abdominal wall around it are used to close the hernia opening
with plasty with synthetic materials (or “tension-free” plasty) – synthetic prostheses made from surgical threads are used to close the hernial opening.

Plastic surgery with own tissues is the oldest group of methods, born in the second half of the 19th century, it is the most extensive and widespread. Its essence is the closure of the hernial ring with the patient’s own tissues (muscles, fascia and aponeuroses) in one way or another. The frequency of hernia recurrence after these operations varies from 20% to 70% depending on the condition of the patient’s tissues, the method of hernioplasty and the correctness of its choice. The main disadvantages are a pronounced pain syndrome for the first days after surgery due to tissue tension and long periods of physical rehabilitation. Intensive physical labor is contraindicated for at least 3 months after surgery.

Tension-free plasty methods for the patient’s own tissues have existed since the second half of the 1960s. They are distinguished from methods of plasty with their own tissues by the use of “patches” made of synthetic materials to close the hernial orifice. In recent years, these methods have gained great popularity, which became possible due to the creation of perfect synthetic materials and the development of new methods for closing the hernia orifices, which practically guarantee the patient from the occurrence of hernia recurrence. The recurrence rate does not exceed 1% in specialized clinics, regardless of the type of hernia. Despite the skin incision over the hernia, pain after surgery is minimal, because. there is no tension on one’s own tissues. Intensive physical labor is possible a month after the operation, household physical activity is not limited. This allows such operations to be performed on an outpatient basis. A positive point is also the possibility of performing the operation under local or spinal anesthesia, which is especially important for the elderly and patients with heart and lung diseases. Due to its reliability and simplicity, hernioplasty according to the I.L. Lichtenstein method – for inguinal hernias – has received the greatest prevalence. It is applicable for any type and size of inguinal hernias.

Fig. Plastic surgery of the inguinal canal with a mesh polypropylene prosthesis according to Liechtenstein .

Laparoscopic (through punctures of the anterior abdominal wall) methods of hernia repair should also be mentioned. These are operations that are performed under the control of a laparoscope – a device that allows using a mini-video camera to eliminate a hernia from the abdominal cavity without cutting the skin over the hernia. They were born in the early 80s of the twentieth century with the advent of video technology. In most cases, the abdominal wall defect is closed from the inside of the abdominal cavity with a synthetic mesh prosthesis.